A 32-year-old male was evaluated during a general health checkup. Clinical examination and transthoracic echocardiography revealed situs inversus with mesocardia. The details of intracardiac anatomy could not be obtained due to restricted echo windows. He underwent cardiac magnetic resonance imaging for comprehensive evaluation. Evaluation showed situs inversus, mesocardia, congenitally corrected transposition of great arteries (CCTGA), and cor triatriatum sinister (A to C, Online Video 1) with moderate pulmonary hypertension. There was a peak gradient of 1.5 m/s on velocity encoded through plane imaging of the restrictive orifice of cor triatriatum (D to G, Online Video 2). It is well known that an additional abnormality causing higher morphological left ventricular pressure improves tricuspid regurgitation and symptoms in CCTGA. In this patient, the clinical management dilemma is because the obstructed cor triatriatum (C and E, arrowheads) is probably maintaining the higher morphological left ventricular pressure.

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